Acute Respiratory Distress Syndrome

Overview

Acute respiratory distress syndrome, or ARDS, is a sudden and serious lung condition where fluid builds up in the tiny air sacs of the lungs. This makes it very hard for oxygen to get into the blood and reach vital organs. ARDS is a medical emergency that usually requires intensive care in a hospital.

ARDS is not common, but it is a serious condition. It often occurs in people who are already very sick in the hospital, especially in intensive care units. Because it can be part of conditions like severe pneumonia or sepsis, thousands of people worldwide are affected each year, but for most people, it is not something they will ever face.

ARDS can affect people of any age, including children and older adults. It is more likely to occur in people who have a severe infection, major injury, widespread inflammation (like pancreatitis), or who have inhaled harmful substances. People with chronic health conditions, such as heart or liver disease, or weakened immune systems, are at higher risk.

Symptoms

Common symptoms

• Severe shortness of breath, often coming on quickly
• Rapid, shallow breathing
• Feeling like you cannot get enough air, even when resting
• Low oxygen levels in the blood, causing bluish or grayish lips, skin, or nail beds
• Confusion, extreme tiredness, or dizziness
• A persistent cough, sometimes with frothy or pink sputum (mucus)
• Fast heartbeat and sweating

Symptoms in children

• Rapid breathing or grunting sounds with each breath
• Flaring of the nostrils when breathing
• Pulling in of the chest muscles or ribs with each breath (retractions)
• Unusual drowsiness or difficulty waking up
• Restlessness or irritability
• Pale or bluish color around the mouth or eyes

Symptoms in older adults

• Older adults may not show the same obvious breathing signs at first. They might just seem more confused, very weak, or less responsive.
• They may have a faster heart rate or a drop in blood pressure.
• Breathing distress may be less noticeable because of other health conditions, so close attention is needed.
• The underlying cause, such as pneumonia or sepsis, may cause fever or low body temperature.

Causes

Main causes

• Severe pneumonia (lung infection from bacteria or viruses, including influenza and COVID-19)
• Sepsis (a life-threatening reaction to an infection that causes widespread inflammation)
• Major trauma, such as a car accident or severe burn injury
• Inhaling harmful substances, like smoke, chemical fumes, or vomit into the lungs
• Severe pancreatitis (inflammation of the pancreas)
• Massive blood transfusions or severe bleeding

Risk factors

• Being critically ill in a hospital, especially in intensive care
• Having a weakened immune system due to illness or medical treatment
• Chronic health conditions, such as chronic lung disease, heart disease, diabetes, or liver disease
• Alcohol misuse or substance use
• Advanced age (older adults are at higher risk)
• Recent major surgery or severe trauma

When to see a doctor

See a doctor urgently if:

• If you or someone you care for has sudden or worsening trouble breathing, call your local emergency number immediately. Do not wait.
• If breathing problems come with chest pain, confusion, or bluish skin, get emergency help right away.
• If a child has rapid breathing, grunting, or is very drowsy, seek emergency care now.

Book a routine appointment if:

• If you have a mild cough, fever, or feel short of breath only when active, see a healthcare provider within a day or two.
• If you have a chronic lung or heart condition and notice any change in your breathing, contact your doctor.
• If you have been in the hospital for a severe illness and are worried about your breathing after discharge, schedule a follow-up.

Diagnosis

ARDS is usually diagnosed in the hospital. Doctors use a combination of physical examination, oxygen level measurements, chest X-rays or scans, and blood tests. They also look for a known cause, like severe infection or trauma, and make sure the oxygen problem is not due to heart failure. There is no single test for ARDS, but the pattern of symptoms and test results helps confirm it.

Tests that may be done

• Pulse oximetry: a small sensor on a finger or ear to measure oxygen levels in the blood
• Chest X-ray: to look for fluid in the lungs and rule out other lung problems
• Blood tests: to check oxygen and carbon dioxide levels, look for infection, and assess organ function
• Echocardiogram or heart tests: to check if heart problems are causing the fluid buildup
• In some cases, a CT scan of the chest or a lung biopsy may be needed to rule out other conditions

What to expect at your appointment

If a doctor suspects ARDS, you will be admitted to a critical care unit. You will be closely monitored with machines that check your heart rate, blood pressure, and oxygen levels. Doctors may insert a tube into your windpipe to help you breathe (mechanical ventilation) if your oxygen stays too low. During testing, you will be kept as comfortable as possible. It can be a frightening time, but the care team will explain each step and support you and your family.

Treatment

ARDS is always treated in a hospital, usually in an intensive care unit (ICU). The main goals are to get enough oxygen into your blood, support your breathing while your lungs heal, and treat the underlying cause (like an infection). Treatment often involves a breathing machine (ventilator), extra fluids, and close monitoring. Recovery takes time, and care is tailored to each person's needs.

Self-care at home

• You cannot treat ARDS at home. It is a lifelong emergency. If you have signs like severe breathlessness, call emergency services.
• While in the hospital, follow all instructions from your care team, including turning, positioning, and movement exercises to help your lungs.
• If you smoke, ask your healthcare team for support to quit. This is one of the best things you can do for your lungs.
• After leaving the hospital, join a pulmonary rehabilitation program if offered, and do gentle breathing exercises as recommended.

Medical treatments

Treatment is supportive and includes oxygen therapy, often through a machine that pushes air into the lungs (mechanical ventilation). Doctors may use techniques to protect the lungs while breathing is supported, such as using lower air pressures or placing you on your stomach (prone positioning). They will also treat the cause: for example, with antibiotics for pneumonia or sepsis, or with other medicines for inflammation. Extra fluids may be given to maintain blood pressure, and sometimes medicines are used to keep a person calm while on a ventilator. Every treatment decision is made by a specialized critical care team.

When is surgery considered?

Surgery is not a direct treatment for ARDS itself, but some people may need a minor procedure to place a tube into the airway or chest, or to insert a central line for giving fluids and medicines. If the underlying cause needs an operation (such as for severe trauma), that surgery may be necessary, but the ARDS is managed medically in the intensive care unit.

Living with this condition

Recovery from ARDS can take weeks to months. You may feel very weak, tired, and short of breath for a while. Daily activities like walking up stairs, lifting, or concentrating may be hard. Plan for rest breaks and gradually increase activity as advised by your care team. Ongoing follow-up with a lung specialist and rehab services can help you rebuild strength.

Lifestyle tips

• Do not smoke or vape, and avoid secondhand smoke and air pollution.
• Take all prescribed medicines for underlying conditions (like asthma or heart disease) as directed.
• Get enough sleep and rest to help healing.
• Avoid people who are sick with colds, flu, or COVID-19 to protect your healing lungs.
• Consider joining a patient support group for people recovering from critical illness.

Diet and exercise

Eat a balanced diet with enough protein, fruits, vegetables, and whole grains to support recovery. If you have difficulty eating at first, ask for help from a dietitian. Gentle exercise, such as walking, stretching, or using a stationary bike, can gradually improve lung function. Always start slowly and check with your doctor before starting a new exercise routine.

Mental health and emotional wellbeing

ARDS is a frightening experience. Many survivors feel anxiety, depression, or post-traumatic stress (PTSD) after their stay in intensive care. They may have bad memories, sleep problems, or fear of shortness of breath. These feelings are normal, but they are not something you have to face alone. Talk to your healthcare team, and ask about counseling or mental health support.

Prevention

Because ARDS usually happens after a severe injury or infection, you cannot always prevent it. However, you can reduce your risk of the conditions that cause it. This includes getting recommended vaccinations, treating infections early, avoiding smoking, and managing chronic health conditions like diabetes or heart disease.

Vaccines

Vaccines can help prevent some infections that lead to ARDS, such as flu, pneumonia, and COVID-19. Ask your healthcare provider about which vaccines are right for you.

Screening programmes

There is no routine screening test for ARDS itself. Screening happens in the hospital when a critically ill person shows signs of breathing trouble. Early detection of lung failure in high-risk patients is part of good intensive care.

Complications

If left untreated

• Without treatment, ARDS can cause dangerously low oxygen levels, leading to severe organ damage or failure.
• It can damage the lungs with scarring (pulmonary fibrosis), making long-term breathing problems more likely.
• It can strain the heart or cause blood pressure to drop, leading to shock.
• It raises the risk of blood clots in the lungs or legs.
• It can lead to muscle weakness, nerve problems, and mental health challenges during recovery.

Long-term outlook

ARDS is a very serious condition, and some people do not survive it. However, many people who receive prompt treatment in an intensive care unit do recover, and their quality of life often improves over time. Recovery may be slow, and some people have lasting lung issues, but most people who leave the hospital continue to get better for many months. With good rehabilitation, support, and follow-up care, there is real hope for a meaningful recovery.

Find support

Local organisations

• Your local health service, such as the NHS in the UK · United Kingdom

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